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The lumbar disc and low back pain.
1Faculty of Medicine, University of Newcastle, New South Wales, Australia.
Neurosurgery Clinics of North America
|October 1, 1991
Summary
Lumbar disc injuries, often from bending and rotation, can cause pain due to outer disc innervation. Degenerative processes can lead to symptomatic internal disc disruption, even without external changes.
Area of Science:
- Orthopedics
- Spine Surgery
- Pain Management
Background:
- The lumbar disc endures compression, tension, and shear forces during spinal movement.
- The outer annulus fibrosus is innervated, making it a potential pain generator.
- Injuries to the annulus fibrosus can occur during flexion and rotation, leading to symptomatic ligamentous injury.
Purpose of the Study:
- To elucidate the mechanisms of lumbar disc injury and pain generation.
- To describe the progression from asymptomatic compression injury to symptomatic internal disc disruption.
- To explain how disc prolapse represents a late stage of disc degeneration.
Main Methods:
- Review of anatomical and biomechanical properties of the lumbar disc.
- Pathophysiological analysis of disc injury progression.
- Clinical correlation of disc degeneration with pain mechanisms.
Main Results:
- Compression injuries initiate asymptomatic degradation, potentially leading to internal disc disruption.
- Internal disc disruption becomes symptomatic via chemical or mechanical irritation of nociceptors in the annulus fibrosus.
- Disc prolapse is a potential end-stage outcome of internal disc disruption.
Conclusions:
- Lumbar disc pain can arise from injuries to the innervated annulus fibrosus.
- Internal disc disruption is a key pathway to symptomatic disc disease, independent of external disc appearance.
- Early asymptomatic disc injuries can progress to significant pathology and pain.